Researchers have identified factors that predict development of acute kidney injury (AKI) in patients with lymphoma, according to a recently published report in the International Journal of Nephrology.

These factors include sepsis, tumor lysis syndrome, the use of diuretics and aminoglycosides, and the use of a chemotherapy regimen consisting of rituximab, cyclophosphamide, vincristine, and prednisolone (R-CVP). In addition, AKI stages 2 and 3 based on Acute Kidney Injury Network criteria were associated with increased mortality and prolonged hospital stay.

The study, by Muhammad Abdul Mabood Khalil, MD, of Aga Khan University Hospital in Karachi, Pakistan,  and colleagues, included 365 lymphoma patients, of whom 116 (31.8%) experienced AKI. To their knowledge, the study is the largest to date looking at AKI in lymphoma patients, they noted.

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“Lymphoma patients are prone to develop AKI due to acute tubular necrosis secondary to sepsis, nephrotoxic medications, and contrast studies,” the authors explained.

Cancer patients may be immunocompromised as a result of multiple factors, including chemotherapy, radiotherapy, impairment of normal leukocyte function, or corticosteroid use. Dysregulation of the immune system predisposes them to sepsis, which can lead to unregulated cytokine release and hemodynamic disturbances, they observed. “AKI usually ensues as a result of alterations in renal perfusion resulting from pro-inflammatory insults.”

“We speculate that tumor lysis syndrome, concurrent sepsis with superimposed use of aminoglycosides, and diuretics use make lymphoma patients prone to develop AKI,” the researchers stated. “This in turn results in more mortality and morbidity. Therefore, patients with high grade lymphoma should be cautiously watched during their chemotherapy as they can potentially deteriorate by developing tumor lysis and subsequent AKI. Similarly, sepsis should be vigorously looked for and treated appropriately.”